The advantages and disadvantages of transurethral resection. What after the course of rehabilitation.
BPH remains one of the most frequent diseases of men older than 35 years.
Currently in medical practice for the treatment of BPH is widely used endoscopic transurethral resection. Thanks resection specialists can not only remove the visible portion of the prostate, but also to restore urination, even in patients with significant comorbidities.
There are two types of prostate surgeries: transurethral resection, and transvesically adenomectomy (open surgery).
The advantages of the first type of operation are:
- after transurethral resection, in contrast to adenomektomii there are no incisions on the outside;
- the time spent in hospital is much less;
- surgery is better tolerated by patients;
- resection is characterized by a lower frequency of occurrence of various complications in the postoperative period.
When conducting transurethral resection of the prostate adenoma the doctor the patient's bladder through the urethra enters a resectoscope (a special medical tool.).
After careful examination of the bladder, urethra and the area where is prostate adenoma (that is, the boundaries of the bladder and urethra), under the precise control of the urologist performs a prostate prostate. The extraction is carried out using a special device – loop.
Transurethral resection requires good visibility in the surgical field, ensured by the inflow and the outflow of liquid through the channels of the resectoscope. When removal of the tissue of the adenoma to violate the desired orientation in the tissue can bleeding from the exposed vessels. Therefore, in order not to lose the visibility you need to quickly stop the bleeding.
The presence of the catheter in the postoperative period should:
- for permanent irrigation, which prevents formation of blood clots and clogging of the outflow channel of the liquid;
- to ensure a constant collapsed state of the bladder.
The duration and intensity of the irrigation of the bladder depending on the severity of staining of the flowing liquid blood. Usually, the lavage is performed for two to four days after the procedure the catheter is removed.
After removal of the Foley catheter in almost all patients with normal urination. However, you can feel sharp pains and urine staining in a pale pink color, but this requires additional surgical interventions.
Not recommended for a longer period to delay the process of urination, as this may lead to a strong filling of the bladder and excessive stretching of the surgery site, which can provoke bleeding.
The main indications for the appointment of resection are the presence of the patient:
- annoying (irritative) symptoms – heaviness and pain above the vagina, frequent and painful urination;
- symptoms significant and moderate obstruction of the bladder – chronic and acute urinary retention;
- the presence often renewable (recurrent) urinary tract infections;
- pseudosocial diverticulum of the bladder;
- the presence of blood in the urine (hematuria recurrent);
- develops on the background of voiding renal failure.
The most commonly transurethral resection prescribed for:
- prostate cancer;
- benign prostatic hyperplasia;
- chronic inflammatory processes in the prostate gland.
Possible postoperative complications of resection
Transurethral resection of prostatic adenoma – a fairly safe procedure, serious complications and side effects are very rare.
They may include:
The syndrome of water intoxication
In the blood during surgery can get a large amount of irrigation fluid, with the result that patients get this syndrome (at risk from 0.2 to 1% of patients).
Usually during resection of the adenoma with a little irrigation liquid enters through the damaged vein in the blood, but it can cause syndrome of intoxication.
It can occur in the first days after surgery and is often the result of improper bleeding during transurethral resection of the prostate. In this case, to stopbleeding assigned the following drugs: dicynone, calcium chloride, etc.
If they don't help, then apply endoscopic surgical diathermy, in rare cases, conducted a public examination of the bladder and the sewing of bleeding vessels.
Retrograde ejaculation (reflux of semen into the bladder)
This is the most common complication occurring after transurethral resection.
Its causes are dysfunction of the internal sphincter of the bladder, functional changes that occur after the implementation of such operations in the posterior urethra and urethral anastomosis.
A complication occurs in 0.5 — 2% of patients as a result of trauma of the external sphincter during resection.
The bladder neck sclerosis and urethral stricture (narrowing of urethra)
Prone to this complication from 2 to 10% of patients.
Recommendations in the postoperative period
Within 60 days after surgery should avoid strenuous exercise and sports (not lift weights weighing more than 3 kg). Do not drink alcohol and hypothermia. Sex life is allowed 6 weeks after transurethral resection of the adenoma.
In addition you should try not to push, particularly during emptying. To speed up the recovery, it is recommended to take plenty of fluids to increase the urine flow and preventing urethral strictures and to follow a diet rich in dietary fiber.
Contraindications to resection of BPH
Contraindications to transurethral resection of the prostate are the heavy condition of the patient: blood clotting disorders, acute diseases, unadjusted coagulopathy, etc.
Operation is contraindicated in infectious and inflammatory diseases of the urogenital organs, as well as in other situations in which it is impossible to carry out the surgery: difficulties with the introduction of the operating instrument into the bladder, ankylosis of the hip joints etc.